Healthcare Provider Details

I. General information

NPI: 1760491450
Provider Name (Legal Business Name): PAIN CARE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N ELM ST SUITE 109
HINSDALE IL
60521
US

IV. Provider business mailing address

LBX 809115 PO BOX 809115
CHICAGO IL
60680-9115
US

V. Phone/Fax

Practice location:
  • Phone: 630-794-9999
  • Fax: 630-794-9998
Mailing address:
  • Phone: 312-787-2998
  • Fax: 312-787-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: NEERAJ JAIN
Title or Position: PRESIDENT
Credential: MD
Phone: 312-787-2998